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The politics of health system metrics, 1924-2000

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This seminar is organised by the Applied Social Science Group at the Primary Care Unit and introduced by Professor Mary Dixon-Woods

This paper documents the development of health system metrics by international organisations and explores their relationship to the changing politics of world health. Its period runs from the 1920s League of Nations Health Organization Yearbooks, which initiated health system statistics, and the World Health Report 2000, in which comparative rankings reached a controversial zenith. Much existing historiography is limited, explaining the growth of measurement as progressive illumination of world population health and medical services. There is also a general critical literature, treating indicators as products of powerful nations which are deployed as instruments of global governance. The empirical discussion here draws on statistical publications of the LNHO , the WHO , the ILO , the OECD and the World Bank. It presents a time series showing change and continuity in the indicators collected and published, which then provides a basis for analysis and explanation. Certain indicators, principally demographic and epidemiologic, appear consistently due to their utilitarian nature and amenability to development thinking. Others, related to institutional provision, workforce, financing and coverage, appear more sporadically, and this is related to changing trends and assumptions in international health. While partly affirming the critical literature, the long-run history of these metrics reveals they were also used by peripheral or resistant actors to challenge or drive policy at the centre.

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